once again we find ourselves overdue for an update.
for the first time i will be missing thanksgiving with my family. if i was celebrating it with friends or some other group it wouldn't be so bad, but i will be celebrating it with ICU nurses and patients who are determined to reach the grave one step earlier than we will let them. this is a depressing prospect.
i thought i would try to make myself feel better by making a turkey sandwich for dinner tomorrow night, but i forgot to buy turkey. so it will be peanut butter, but i will pretend that it is sweet delicious roast turkey with stuffing and cranberry sauce and mashed potatoes and green bean casserole. then i will pretend to curl up on the couch and watch football til i pass out in a tryptophan coma when really i will be drawing bloods and informing family members that their beloved aunts and uncles and mothers and fathers and grandparents are imminent and this is really serious and they should be prepared for an outcome that may not be the best case scenario, no matter how much they pray, and that auntie may not ever wake up even though she twitched a toe after 2 weeks of complete unresponsiveness, no matter how well christopher reeve was doing after his accident, and just because we are going to ask the surgeons to slice open their neck and put in a tracheostomy doesn't mean they're going to be awake and talking again, and that large mass that is growing in the upper lobe of their left lung isn't going to go away and it keeps getting bigger and bigger and one day it will keep them from breathing properly and that day could be very soon but in the meantime we really need to open a bed in the ICU so we may be sending them out tomorrow.
it's hard not to assume such a horrible, cynical view of the inevitably dying patient while you're working in the ICU. i spent 90 minutes this morning compressing the right femoral vein of a 55 year old diabetic cocaine user, because the doctors previously treating her had suspected she had a bloodclot in her lung and gave her blood thinners and then decided to try to put in a femoral central line and missed and she bled and bled and bled and bled and her hematocrit slowly went from above 30 to about 15 in the span of 3 hours (she didn't have a blood clot). around the same time this happened, a 47 year old guy who came in with a stroke started having a seizure while he was on dialysis and afterwards became very agitated and aggressive and nearly pulled out his dialysis catheter (which is a huge, huge IV that would very likely spell disaster if forcibly removed). and one of our patients died today, an IV drug user with a crapped out cirrhotic liver who had never even had anything approaching a viable mental status throughout his entire stay in the ICU, who had no family we could contact and only had a common-law wife who did not own a telephone and only appeared twice and we were sending her telegrams (seriously) with daily updates of his deteriorating condition as each of his organ systems went from barely functional to completely failed, one-by-one, and to whom we sent another telegram this afternoon informing her that he had passed.
honestly i don't know what my point is, i'm just saying that today was hectic and crazy and scary and i feel completely worn out and exhausted and tired but more so mentally than physically. my head hurts.
anyway, i've eaten my tuna sandwich dinner and i'm tired and dirty and would like a nice shower and pass out in bed while reading one of the three books or two magazines i'm slowly plodding my way through.
and so and on and on and on and on, and so it goes.
this educational lesson brought to you by dr. j around 7:58 PM | 